1,721,251 research outputs found
Assessing the severity of atrophic gastritis
No full textAtrophic gastritis, mainly the consequence of long-standing Helicobacter pylori infection, is linked to the development of gastric cancer. In the case of atrophic gastritis, severity may be mainly related to the lifetime risk of the single patient to develop gastric cancer, mostly in relation to the degree and extension of mucosal damage. As atrophic gastritis is the result of complex multifactorial interactions, the application of artificial neural networks is promising and may be useful for the identification of those patients with atrophic gastritis at higher risk for gastric malignancies. The experience of application of artificial neural networks in atrophic gastritis is still scarce. The available data suggest that these systems may contribute to identify patients with corporal metaplastic atrophic gastritis and to optimize bioptic sampling during gastroscopy. © 2007 Lippincott Williams & Wilkins, Inc
Mesalamine (5-ASA) for the Prevention of Recurrent Diverticulitis (Review)
No full textBackground Mesalamine, or 5-aminosalicylic acid (5-ASA) has been studied for the prevention of recurrent diverticulitis. Objectives To evaluate the efficacy of mesalamine (5-ASA) for the prevention of recurrent diverticulitis. Search methods We searched databases from 2010 to September 2017. In addition, we scanned reference lists from eligible publications, and we contacted corresponding authors to ask about additional trials. Selection criteria We included randomized controlled clinical trials comparing the efficacy of 5-ASA versus placebo or another active drug for the prevention of recurrent diverticulitis. Main results We included in this review seven studies with a total of 1805 participants. We judged all seven studies to have unclear or high risk of bias. Investigators found no evidence of an effect when comparing 5-ASA versus control for the prevention of recurrent diverticulitis (31.3% vs 29.8%; RR 0.69, 95% confidence interval (CI) 0.43–1.09); very low quality of evidence). Five of the seven studies provided data on adverse events of 5-ASA therapy. The most commonly reported side effects were gastrointestinal symptoms (epigastric pain, nausea, and diarrhea). No significant difference was seen between 5-ASA and control (67.8% vs 64.6%; RR 0.98, 95% CI 0.91–1.06; P = 0.63; moderate quality of evidence), nor was significant heterogeneity observed (I2 = 0%; P = 0.50). Authors’ conclusion The effects of 5-ASA on recurrence of diverticulitis are uncertain owing to the small number of heterogenous trials included in this review. Rates of recurrent diverticulitis were similar among participants using
5-ASA and control participants. Effective medical strategies for the prevention of recurrent diverticulitis are needed, and further randomized, double-blinded, placebo-controlled trials of rigorous design are warranted to specify the effects of 5-ASA (mesalamine) in the management of diverticulitis
[Chemotherapy and NSAIDs in neoplastic disease. Role of anti-secretory preventive therapy].
No full textThe patients treated by chemotherapy should be considered at high-risk for developing serious lesions of upper gastrointestinal tract. Several factors should be considered during the initial management of these patients, such as the presence and the staging of the malignancy, the cytotoxic effects of the antiblastic drugs, the co-administration of NSAIDs and corticosteroids, and the possible co-existence of Helicobacter pylori infection, hiatal hernia, and gastro-esophageal reflux. In order to prevent gastro-duodenal damage, the optimal approach first has to include an accurate clinical and pharmacological evaluation. The upper gastrointestinal endoscopy should also be performed in neoplastic patients undergoing chemotherapy before starting treatment. Proton pump inhibitors can play a major role in these patients to prevent gastro-duodenal damages, and to relieve dyspeptic symptoms
Letter: gastric cancer and pernicious anaemia--often Helicobacter pylori in disguise--authors' reply.
No full textProbiotics and Diverticular Disease. Evidence-based?
No full textDiverticular disease (DD) is a common gastrointestinal condition. Clinical spectrum ranges from asymptomatic diverticulosis to symptomatic uncomplicated or complicated DD. Symptoms related to uncomplicated DD are not specific and may be indistinguishable from those of irritable bowel syndrome. Low-grade inflammation, altered intestinal microbiota, visceral hypersensitivity, and abnormal colonic motility have been identified as factors potentially contributing to symptoms. Probiotics may modify the gut microbial balance leading to health benefits. Probiotics, due to their anti-inflammatory effects and ability to maintain an adequate bacterial colonization in the colon, are promising treatment options for DD. This review focuses on the available evidence on the efficacy of prebiotics in uncomplicated DD
Pernicious anemia: New insights from a gastroenterological point of view
No full textPernicious anemia (PA) is a macrocytic anemia that is caused by vitamin B12 deficiency, as a result of intrinsic factor deficiency. PA is associated with atrophic body gastritis (ABG), whose diagnosis is based on histological confirmation of gastric body atrophy. Serological markers that suggest oxyntic mucosa damage are increased fasting gastrin and decreased pepsinogen I. Without performing Schilling's test, intrinsic factor deficiency may not be proven, and intrinsic factor and parietal cell antibodies are useful surrogate markers of PA, with 73% sensitivity and 100% specificity. PA is mainly considered a disease of the elderly, but younger patients represent about 15% of patients. PA patients may seek medical advice due to symptoms related to anemia, such as weakness and asthenia. Less commonly, the disease is suspected to be caused by dyspepsia. PA is frequently associated with autoimmune thyroid disease (40%) and other autoimmune disorders, such as diabetes mellitus (10%), as part of the autoimmune polyendocrine syndrome. PA is the end-stage of ABG. Longstanding Helicobacter pylori infection probably plays a role in many patients with PA, in whom the active infectious process has been gradually replaced by an autoimmune disease that terminates in a burned-out infection and the irreversible destruction of the gastric body mucosa. Human leucocyte antigen-DR genotypes suggest a role for genetic susceptibility in PA. PA patients should be managed by cobalamin replacement treatment and monitoring for onset of iron deficiency. Moreover, they should be advised about possible gastrointestinal long-term consequences, such as gastric cancer and carcinoids. © 2009 The WJG Press and Baishideng. All rights reserved
Systematic review: Impaired drug absorption related to the co-administration of antisecretory therapy
No full textBackground Due to suppression of gastric acidity during antisecretory therapy, an impaired absorption of co-administered drugs may occur. Aim To review evidence of impaired drug absorption related to the use of co-administered PPIs or H 2RAs. Methods Systematic search of MEDLINE/EMBASE/SCOPUS databases (1980-September 2008) for English articles with keywords: drug malabsorption and absorption, stomach, anti-secretory / acid inhibitory drugs, histamine H 2 antagonists, PPIs, gastric acid, pH, hypochlorhydria, gastric hypoacidity. From 2126 retrieved articles, 16 randomized crossover studies were identified investigating impaired absorption of nine different drugs in association with co-administration of PPIs or H 2RAs. Information on investigated drug, study type, features of investigated subjects, study design, type of intervention, and study results were extracted. Results The identified studies investigated the absorption kinetics of nine drugs. Acid suppression reduced absorption of ketoconazole, itraconazole, atazanavir, cefpodoxime, enoxacin and dipyridamole (median C max reduction by 66.5%). An increased absorption of nifedipine and digoxin (median AUC increase by 10%) and a 2-fold-increase in alendronate bioavailability were observed. Conclusions Gastric pH appears relevant for absorption of some cardiovascular or infectious disease agents. Antisecretory treatment may significantly modify the absorption of co-administered drugs. © 2009 Blackwell Publishing Ltd
Italian guidelines of Diverticular Disease
No full textDiverticular disease (DD) is a widespread condition, however limited evidences are available about its management and complications. In the last years, an Italian Consensus Conference promoted by GRIMAD (Gruppo Italiano Malattia Diverticolare, Italian Group on Diverticular Diseases) and a Guideline, by Italian Society of Colorectal Surgery (SICCR) were published. The aim of the Consensus was to provide clinical recommendation for appropriate definition, diagnosis, and management of DD, in particular 4 areas of interest were identified, namely: (i) definition and epidemiology, (ii) pathophysiology, (iii) diagnosis, and (iv) medical and surgical treatment. A total of 55 statements graded according to different level of evidence and strength of recommendation were approved. However, if we consider the grade of recommendation, their strength remains suboptimal, with only 3 statements with grade of evidence A in the area of diagnosis. The Clinical guidelines by SICCR focus mainly on acute diverticulitis, and surgical treatment of complicated DD. One of the main topic analyzed, is represented by the management of the acute uncomplicated diverticulitis, in particular about the use of antibiotics and need of hospitalization. Despite the presence of many recent European and western country guidelines, there is a lack of robust data on epidemiology, risk factors, and medical and surgical management of DD, calling the need of further studies aimed to obtain an evidence-based approach in this condition
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